Senate Bill NO. 2573

By Senator(s) Nunnelee, Ross

SECTION *. The following section shall be codified in Chapter 15 of Title 25:

(1) The State and School Employees Health Insurance Plan shall provide an enrollee who is receiving benefits in connection with a mastectomy and who elects breast reconstruction in connection with such mastectomy, coverage for all stages of reconstruction of the breast on which the mastectomy has been performed; surgery and reconstruction of the other breast to produce a symmetrical appearance; and prostheses and physical complications of mastectomy, including lymphedemas in a manner determined in consultation with the attending physician and the patient. Such coverage may be subject to annual deductibles and coinsurance provisions as may be deemed appropriate and as are consistent with those established for other benefits under the plan. Written notice of the availability of such coverage shall be delivered to the certificate holder upon enrollment and annually thereafter.

(2) The State and School Employees Health Insurance Plan shall provide notice to each enrollee regarding the coverage required by this section. Such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the plan and shall be transmitted to the enrollee not later than July 1, 2000.

(3) The State and School Employees Health Insurance Plan may not:

(a) Deny to a patient eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan solely for the purpose of avoiding the requirements of the section; or

(b) Penalize or otherwise reduce or limit the reimbursement of an attending provider or provide incentives (monetary or otherwise) to an attending provider to induce such provider to provide care to an enrollee in a manner inconsistent with this section.

(4) Nothing in this section shall be construed to prevent the plan from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section.

AND THE STATE AND SCHOOL EMPLOYEES HEALTH INSURANCE PLAN